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      Why Do Nurses Fail to Implement Pain Assessment Instruments for Hospitalized Infants?

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          Abstract

          Background:

          Effective pain assessment in neonatal care is crucial for ensuring the well-being of newborns. However, barriers to its successful implementation persist. This study aims to identify the obstacles that hinder effective neonatal pain assessment by Neonatal Intensive Care Units (NICUs) nurses.

          Materials and Methods:

          This qualitative study was conducted using the method of conventional content analysis. Purposive sampling was employed from February to September 2023, selecting 14 female nurses working in NICUs of hospitals in Tehran and Karaj as participants. Indepth, semistructured interviews were conducted to collect the data. The software “MAXQDA” version 2016 was utilized for managing qualitative data.

          Results:

          Four main themes and eleven subthemes were identified: “Overtasked,” “Discordant atmosphere,” “Soulless care,” and “Lack of awareness.” Each of these main themes is further elaborated through the subsequent subthemes.

          Conclusions:

          This study found that the lack of knowledge and understanding of neonatal pain assessment tools, the busyness of nurses, lack of time, excessive documentation, and the inadequacy of staff relative to the number of newborns were the most significant obstacles to the assessment of newborn pain. Addressing these challenges is critical for optimal neonatal pain assessment and management, promoting the well-being of newborns.

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          Most cited references29

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          Methodological challenges in qualitative content analysis: A discussion paper.

          This discussion paper is aimed to map content analysis in the qualitative paradigm and explore common methodological challenges. We discuss phenomenological descriptions of manifest content and hermeneutical interpretations of latent content. We demonstrate inductive, deductive, and abductive approaches to qualitative content analysis, and elaborate on the level of abstraction and degree of interpretation used in constructing categories, descriptive themes, and themes of meaning. With increased abstraction and interpretation comes an increased challenge to demonstrate the credibility and authenticity of the analysis. A key issue is to show the logic in how categories and themes are abstracted, interpreted, and connected to the aim and to each other. Qualitative content analysis is an autonomous method and can be used at varying levels of abstraction and interpretation.
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            Abstraction and interpretation during the qualitative content analysis process

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              Early Neonatal Pain—A Review of Clinical and Experimental Implications on Painful Conditions Later in Life

              Modern health care has brought our society innumerable benefits but has also introduced the experience of pain very early in life. For example, it is now routine care for newborns to receive various injections or have blood drawn within 24 h of life. For infants who are sick or premature, the pain experiences inherent in the required medical care are frequent and often severe, with neonates requiring intensive care admission encountering approximately fourteen painful procedures daily in the hospital. Given that much of the world has seen a steady increase in preterm births for the last several decades, an ever-growing number of babies experience multiple painful events before even leaving the hospital. These noxious events occur during a critical period of neurodevelopment when the nervous system is very vulnerable due to immaturity and neuroplasticity. Here, we provide a narrative review of the literature pertaining to the idea that early life pain has significant long-term effects on neurosensory, cognition, behavior, pain processing, and health outcomes that persist into childhood and even adulthood. We refer to clinical and pre-clinical studies investigating how early life pain impacts acute pain later in life, focusing on animal model correlates that have been used to better understand this relationship. Current knowledge around the proposed underlying mechanisms responsible for the long-lasting consequences of neonatal pain, its neurobiological and behavioral effects, and its influence on later pain states are discussed. We conclude by highlighting that another important consequence of early life pain may be the impact it has on later chronic pain states—an area of research that has received little attention.
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                Author and article information

                Journal
                Iran J Nurs Midwifery Res
                Iran J Nurs Midwifery Res
                IJNMR
                Iran J Nurs Midwifery Res
                Iranian Journal of Nursing and Midwifery Research
                Wolters Kluwer - Medknow (India )
                1735-9066
                2228-5504
                Jan-Feb 2025
                15 January 2025
                : 30
                : 1
                : 123-129
                Affiliations
                [1 ] Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
                [2 ] Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
                Author notes
                Address for correspondence: Prof. Abbas Ebadi, Nursing Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, IR Iran. E-mail: ebadi1347@ 123456yahoo.com ; ebadi1347@ 123456bmsu.ac.ir
                Article
                IJNMR-30-123
                10.4103/ijnmr.ijnmr_347_23
                11881964
                40052040
                529bd7ea-0bd0-4a29-9c6e-0c1faf12a351
                Copyright: © 2025 Iranian Journal of Nursing and Midwifery Research

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 06 November 2023
                : 13 June 2024
                : 15 June 2024
                Funding
                Islamic Azad University of Medical Sciences in Tehran
                Categories
                Original Article

                Nursing
                infant,intensive care,neonatal,nurses,pain,pain measurement,qualitative research
                Nursing
                infant, intensive care, neonatal, nurses, pain, pain measurement, qualitative research

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